Healthcare Provider Details

I. General information

NPI: 1841519261
Provider Name (Legal Business Name): MS. VERONICA ELIZABETH BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. VERONICA ELIZABETH MATTHEWS

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US 1 S STE 100, FAMILY PRACTICE 2
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US 1 S STE 100, FAMILY PRACTICE 2
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-5055
  • Fax: 904-825-5076
Mailing address:
  • Phone: 904-825-5055
  • Fax: 904-825-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: